内镜下醋酸染色联合窄带光成像在胃癌早期诊断中的病理一致性研究

Study on pathologic consistency of endoscopic acetic acid staining combined with narrow band light imaging in early diagnosis of gastric cancer

目的:研究内镜下醋酸染色联合窄带光成像(Narrow band light imaging,NBI)在胃癌早期诊断中的病理一致性。方法:选取2021年1月至2022年12月期间本院收治的127例疑似早期胃癌患者作为研究对象。所有研究对象均需接受常规胃镜、单纯NBI、NBI联合内镜下醋酸染色检查。比较三种检查图像清晰度;以病理检查为“金标准”,分析三种检查方式检出率、诊断价值,及与病理检查的一致性。结果:经病理检查确诊早期胃癌患者118例。病变轮廓、黏膜腺管开口、浅表毛细血管结构3分图像清晰度占比:NBI联合内镜下醋酸染色检查>单纯NBI>常规胃镜,组间比较有统计学意义(P<0.05)。常规胃镜检出99例,单纯NBI检出103例,NBI联合内镜下醋酸染色检出115例。NBI联合内镜下醋酸染色检查灵敏度、特异度、诊断符合率、阳性预测值(Positive predictive value,PPV)及阴性预测值(Negative predictive value,NPV)均显著高于单纯NBI、常规胃镜检查(P<0.05)。经Kappa检验,NBI联合内镜下醋酸染色检查与金标准的一致性高于常规胃镜、单纯NBI(P<0.05)。结论:内镜下醋酸染色联合NBI可清楚显示胃癌早期微血管、微腺管等形态,优于单纯NBI检查及常规检查,且与早期胃癌的病理检查具有极好的一致性。两者联合在早期胃癌诊断中具有较高的诊断价值。

Objective:To study the pathological consistency of endoscopic acetic acid staining combined with NBI in early diagnosis of gastric cancer.Methods:A total of 127 patients with suspected early gastric cancer admitted to our hospital from January 2021 to December 2022 were selected as the study objects.All subjects underwent conventional gastroscopy,NBI alone,and NBI combined with endoscopic acetic acid staining examination.Compare the sharpness of the three inspection images;Taking pathological examination as the"gold standard",the detection rate,diagnostic value and consistency with pathological examination were analyzed.Results:118 patients with early gastric cancer were confirmed by pathological examination.The resolution ratio of lesion contour,mucosal glandular duct opening and superficial capillary structure in 3 points:NBI combined with endoscopic acetic acid staining examination>simple NBI>conventional gastroscopy,with statistical significance between groups(P<0.05).99 cases were detected by routine gastroscopy,103 cases by NBI alone,and 115 cases by NBI and endoscopic acetic acid staining.The sensitivity,specificity,diagnostic coincidence rate,PPV and NPV of NBI combined with endoscopic acetic acid staining examination were significantly higher than those of NBI alone and routine gastroscopy(P<0.05).After Kappa test,the consistency of NBI combined with endoscopic acetic acid staining examination with gold standard was higher than that of conventional gastroscopy and NBI alone(P<0.05).Conclusion:Endoscopic acetic acid staining combined with NBI can clearly show the morphology of microvessels and microglandular tubes in early gastric cancer,which is superior to NBI and routine examination,and has excellent consistency with the pathological examination of early gastric cancer.The combination of the two has high diagnostic value in the early diagnosis of gastric cancer.